BACKGROUND Many causes of pelvic pain in adolescent women are similar to adult women. However, there are some specific problems that relate to obstructive congenital anomalies, and acute pelvic pain, caused by ovarian torsion, is also more common in this age group. OBJECTIVE This article discusses the approach to the assessment of pelvic pain in adolescent women and outlines causes that are specific to this patient population. DISCUSSION Despite the many similarities in the aetiology of pelvic pain, there are some critical differences in the approach and management of adolescents that need careful consideration. Establishing good communication, clarifying the issues around confidentiality, and understanding the requirements for gaining valid consent are essential. Undertaking a general health risk screening is invaluable to understanding of some of the broader social issues that may be impacting on the pain, as well as increasing your understanding of the impact that the pain is having on the patient's life. These issues will impact on your capacity to successfully manage the young woman, and her presentation with pelvic pain.